ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME (-4e q) OUI, we !t-1 PHONE # 5 I y I &q
ADDRESS
NAME OF MOBILE HOME PARK OR S/D ~~25; +ti.r,,,((
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) PROPERTY LOCATION: STATE ROAD NAME AND v
PURPOSE OF INSPECTION: De t
.The aforementioned site has been evaluate byte Harnett County ea Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
D9 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
U -A- ((-q 0
- D'~) - ~ 13
Date
Signature of En
Health Specialist